Browsing MS3 Discovery & Inquiry Theses by Issue Date
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ItemTeleretinal Screening for Diabetic Retinopathy in Central Texas(2019-05-10) Elwood, KevinTeleretinal imaging for diabetic retinopathy is an effective screening program in urban and rural populations. This screening modality began in Central Texas in 2015 and has expanded to include 12 cameras located at primary care offices in the region. Year after year trending of diabetic retinopathy rates, calculated via teleretinal screening, at individual camera locations has not been well documented in the United States. This report studied the teleretinal screening detection rate of diabetic retinopathy at 12 Central Texas camera locations over 2-4 years of camera usage. The rate of detected retinopathy statistically significantly decreased over the years. This suggests the effectiveness of the telemedicine program in removing diabetic retinopathy patients from the screening population and into a retina physician’s care, reducing the number of diabetics with retinopathy in the screened population. ItemThe Impact of Inter-Hospital Transfer on Clinical Outcomes following Endovascular Treatment for Acute Ischemic Stroke(2019-05-10) Schmidt, TylerPURPOSE Hospitals designated as primary stroke centers offer noninvasive treatment for acute ischemic stroke, but only comprehensive stroke centers are equipped to provide endovascular treatment. When stroke patients needing endovascular treatment present to the emergency department at a primary stroke center, they then require inter-hospital transfer to a comprehensive center for definitive treatment. Recent studies have found significant treatment delays and poor clinical outcomes in patients requiring inter-hospital transfer1,2. The primary aim of this study is to determine if inter-hospital transfer impacts clinical outcomes after endovascular treatment for acute ischemic stroke. A secondary aim is to determine whether inter-hospital transfer coincides with any significant treatment delay. METHODS This study involves retrospective chart review for 107 patients undergoing endovascular treatment for acute ischemic stroke at one of three hospitals in Austin, Texas from October 2016 to September 2018. 26 patients required inter-hospital transfer, while 81 (the control group) presented directly to a hospital offering endovascular treatment. Two-tailed T- and U-tests were used for analysis of parametric and non-parametric variables pertaining to time intervals and baseline characteristics. Odds ratios were calculated to compare dichotomized outcomes between groups, with significance determined by chi-square. RESULTS Inter-hospital transfer significantly prolonged onset to groin (mean difference = 37.2 min, p=.02). The transfer group was more likely to experience intracranial hemorrhage (53.9% > 22.2%, p<.01). Clinical outcomes did not significantly differ between groups. CONCLUSIONS Although observed trends in these data suggest poor outcomes for transfer patients, small sample size limits the significance of these findings. However, the significant treatment delay seen in the transfer group warrants a discussion on city protocol changes regarding patient transport via emergency services. Protocol changes favoring direct delivery of patients to comprehensive stroke centers may reduce treatment delay and yield improved clinical outcomes.